A: I attended medical school at University of California, Irvine. I completed my pediatric residency internship, categorical pediatric residency, and pediatric cardiology fellowship at University of California at Los Angeles Mattel Children’s Hospital School of Medicine.

A: My team provides state-of-the-art ultrasound technology and comprehensive fetal cardiac imaging protocol for evaluation and diagnosis of fetal cardiac disease. We offer the only comprehensive fetal cardiology services in Orange County, including performing fetal echocardiograms on pregnant women. When necessary, we partner with families on prenatal palliative care planning for specialized cases. We also support continuity of care of prenatal patients with their primary obstetrical and perinatology teams when appropriate.

Q: What would you most like community/referring providers to know about you or your division at CHOC?

A: I treat every patient and family as though they are my very own. This connection is what has allowed to us create such an amazing network of heart families. I am proud to serve as a member of a supremely talented and highly subspecialized team of cardiologists.

Q: What inspires you most about the care being delivered here at CHOC?

A: CHOC offers the ability for physicians such as me to serve a widely diverse patient population inside and outside of the county. There is a unique and exceptional opportunity for one-on-one personalized care here at CHOC that doesn’t exist in other centers. In this role, I am honored to learn from my patients and families every day, including aspects of their backgrounds, cultures, spectrum of disease, and their perspectives. These are lessons that make me a stronger person and professional to support families in the future.

Q: Why did you decide to become a doctor?

A: My parents are exceptional role models. They remind me to this day that when I was eight years old, I informed them I wanted to take care of babies and their hearts. They are still not quite sure from where the specific inspiration stemmed (perhaps because they are also in the health profession), but they said that I was determined to follow through on this goal, and I did.

Q: What are your hobbies/interests outside of work?

A: My two-year-old daughter and my husband are my life. We play, cook, travel, and explore every aspect of the outside world together. We pride ourselves on learning every trade possible that enhances our lives. We have remodeled our entire home with our own bare hands, cook our meals from scratch, and thoroughly enjoy every aspect of creative design (event planning and decorating and all things arts and crafts).

Q: What have you learned from your patients, or what is the funniest thing a patient has ever told you?

A: One of the funniest moments was when my 4-year-old patient being wheeled into the operating room to undergo a heart transplant asked me if they could put “mac n’ cheese” in her IV.

Meagan and Dante Cipulli quickly settled on a name when they discovered their third baby would be a boy: Marco, which meant God of War.

And that name would become especially apt a few weeks later. When Meagan was about six months pregnant, the couple learned their baby had a congenital heart defect called tetralogy of Fallot and would need open-heart surgery soon after birth.

“Knowing my unborn baby would need open-heart surgery after birth was the scariest experience of my life,” Meagan says. “After receiving his diagnosis, we realized we couldn’t have picked a better name for our little heart warrior.”

Finding heart defects before birth

When a second ultrasound by a perinatologist confirmed that baby Marco’s aorta was enlarged, Meagan was referred to CHOC pediatric cardiologist Dr. Nita Doshi.

Dr. Doshi performed a fetal echocardiogram, which uses sound waves to create a picture of an unborn baby’s heart.

The evaluation confirmed that Marco had tetralogy of Fallot, a heart condition comprised of four related defects that cause inadequate amounts of blood to reach the lungs for oxygen, thus sending oxygen-deficient blood throughout the body.

“I was in complete shock,” Meagan says. “As a nurse, I knew exactly what tetralogy of Fallot was and that he would need open-heart surgery.”

Planning began immediately. With the help of Dr. Doshi, the Cipullis began researching hospitals, cardiologists and surgeons who could care for Marco when the time came.

CHOC emerged as the clear choice, and the Cipullis opted for Dr. Doshi to continue as Marco’s cardiologist and Dr. Richard Gates to perform the corrective surgery.

Organizing pre- post-birth care

Meagan moved her obstetric care to a physician aligned with St. Joseph Hospital so Marco could be transferred next door to CHOC’s neonatal intensive care unit (NICU) immediately upon birth.

During a perinatal conference, the Cipullis met with the obstetrical team at St. Joseph and CHOC’s neonatal team to discuss the baby’s birth and care.

“That allowed me to have all my questions answered and gave me peace of mind that all those related to our care were on the same page,” Meagan said. “I knew that I had made the right choice after meeting with the care team.”

The remaining weeks of Meagan’s pregnancy were an emotional roller coaster. They couple prepared their older sons as best they could for what was to come with their younger brother.

And while the family was scared to not understand the full extent of their baby’s medical needs, they felt assured knowing a plan was in place.

“Each day of my pregnancy after diagnosis was filled with worry and fear, but also gratitude and hope knowing we were fortunate enough to have Marco’s diagnosis in utero and we were able to plan for his care after birth,” Meagan says.

The Cipullis didn’t have to wait long for Marco. On May 16, 2017, Marco was born five weeks ahead of schedule. After a brief rest on his mother’s chest, Marco was moved to CHOC’s NICU, where he stayed for five days.

Surgery day

Marco was back at CHOC about three months later for surgery with Dr. Gates to repair his heart defects.

“At first it all seemed so surreal and somehow I was able to keep it all together until the moment they wheeled Marco into the operating room,” Meagan says. “While he was lying in the crib, he looked over his shoulder and gave me and his dad this smile and look like, ‘I got this, guys, don’t worry.’ I don’t think I have ever cried harder in my life.”

Today, Marco is happy and healthy 9-month-old who loves to smile and laugh. He sees Dr. Doshi every four months for follow-up appointments, but otherwise requires no additional medication or therapy.

Many babies with tetralogy of Fallot will require additional surgeries as they age, but the Cipullis are hopeful that Marco’s early interventional measures will last for many years.

Feeling positive

Meantime, the Cipullis are enjoying every minute with their three boys, and are grateful for the care they received at CHOC after catching Marco’s condition early.

Meagan recommends that other families who find themselves in similar situations be vocal about their fears, but also stay positive about their baby’s future.

“My husband and I each night would talk about what we were feeling that day,” she recalls. “At first, it was more about our fears and worries, but eventually each day we would talk more about our excitement and joy to meet our little warrior.”

A pilot program at CHOC Children’s is giving cardiac patients and their families more peace of mind. Launched by pediatric cardiologist and CHOC’s chief intelligence and innovation officer Dr. Anthony Chang, the CHiP (Cardiopulmonary Health intelligence Program) clinic provides home monitoring equipment to families for the purpose of tracking patients’ vitals, such as blood pressure and oxygen saturation. Through telepresence, families can also connect with their physicians without leaving their homes.

“Patients and families feel more comfortable outside the clinical setting. But when away from the hospital, parents can feel very anxious about their children’s health and well-being,” explains Dr. Chang. “Our CHiP clinic ensures continuity of care, while providing great comfort to parents who know they can connect with their physicians without visiting their offices.”

CHiP is based on another innovative idea from Dr. Chang: the iClinic. According to Dr. Chang, the iClinic is a philosophy of leveraging emerging technologies to help create efficiencies, improve workflow and the continuity of care for patients by bringing CHOC expertise to patients’ homes. The ultimate goal is improving quality care and positive outcomes for patients.

There are five key components of the iClinic, all starting with the letter “I”:

Instantaneous – Instead of periodic measurements at home, monitoring devices can measure at any time.

Intermittent – Instead of being limited to scheduled visits, virtual visits can happen at any time. These virtual visits can include educational sessions, in addition to wellness checks.

Individual therapy – Precision medicine is built into the iClinic, including genomics and pharmacogenomics, to find the medicine or treatment best suited for the patient.

Intelligent data-driven medicine – All data is compiled and analyzed to make the best possible decisions, including personalized medicine and drug discovery.

Intuitive interactions – Through telepresence and the ability to provide instantaneous data with feedback, the iClinic contributes to an experience that feels authentic and intuitive.

Dr. Chang envisions rolling the “clinic of the future” to other specialties at CHOC, beyond CHiP.

“This is the clinic of the future. It is inclusive of wearable devices, avatars, artificial intelligence and genomic medicine. But it’s important to note we’re not using the technology for the sake of just using fancy gadgets. We are leveraging emerging technologies to really change how we deliver care in the best possible way,” explains Dr. Chang.

Providers who are interested in piloting a similar program at their institutions are free to contact Dr. Chang at achang@choc.org.

Led by Dr. Wyman Lai, medical director of echocardiography and co-medical director of the CHOC Children’s Heart Institute, and Anita Moon-Grady, from University of California, San Francisco, the event provided vital education on how to detect serious heart defects during pregnancy, and how to discern when to refer to a fetal cardiology specialist for further testing, counseling and intervention. Additionally, education was provided on the current International Society for Ultrasound in Obstetrics and Gynecology (ISUOG) and American Society of Echocardiography (ASE) guidelines, including: how to improve screening efficacy; acquire the ability to rule out or assess for selected complex anomalies during fetal cardiology screening; diagnose obstructive left heart lesions and counsel families on treatment options and prognoses; use key features reviewed to diagnose heterotaxy syndrome; counsel patients on the benefits and limitations of early fetal echocardiography; and diagnose tetralogy of Fallot, its variants and when to refer to a pediatric cardiologist for treatment.

More than a dozen cases were presented by various speakers and featured obstructive left heart lesions, Heterotaxy syndromes, early fetal echocardiography and variants of tetralogy of Fallot. Keynote speakers included Dr. Wayne Tworetzky from Boston Children’s and Dr. Lynn Simpson from Columbia.

A major highlight of the conference was a live demonstration of a fetal echocardiogram performed by Dr. Wyman Lai on a pregnant patient with a fetus who presented with tetralogy of Fallot. As he demonstrated the procedure on the large screen, attendees were enthralled with Dr. Lai’s presentation and diagnosis.

With the growing number of neonates with congenital heart disease, an upcoming CHOC Children’s conference will provide critical information for medical providers who are diagnosing and treating this complex patient population.

TheNeoHeart: Cardiovascular Management of the Neonateconference, held on March 22-25, 2017 at the Manchester Grand Hyatt in San Diego, will cover pre- and post-operative management of complex heart disease, latest in the management of pulmonary hypertension, neonatal myocardium and hemodynamics, among others topics.

“The intent of the conference is to advocate for a team approach between the NICU, cardiac ICU, cardiology, and cardiac surgery for state-of-the-art cardiovascular management of the neonate, with the focus entirely on the patient,” says Dr. Amir Ashrafi, cardiac neonatologist at CHOC, and conference co-chair.

The anticipated event is expected to draw over 500 attendees from more than 11 countries. This includes top experts in the field, such as keynote speaker, Dr. William I. Norwood, Jr., founder of the Norwood procedure – a three-stage heart surgery that creates a new functional systemic circuit in patients with hypoplastic left heart syndrome. A special dinner with Dr. Norwood on his legendary career is slated for March 22.

Given the outcomes and interest surrounding the conference in the last few years, Dr. Ashrafi and his colleagues launched the first international neonatal heart society. The group plans to work closely with other professional organizations such as The Pediatric Cardiac Intensive Care Society.

To register for NeoHeart: Cardiovascular Management of the Neonate, visit CHOC’s website.